The National Institutes of Health’s National Institute on Drug Abuse has awarded a five-year $3,488,576 R01 grant to multi-PI, Dr. Katherine Martucci of Duke Anesthesiology, for the project titled, “Neural Correlates and Behavioral Impact of Withdrawal-Induced Hyperalgesia Among People who Smoke With and Without Chronic Pain.”
Tobacco smoking is extremely addictive and remains a leading cause of preventable death. Individuals with chronic pain are approximately twice as likely to smoke cigarettes as those without pain, and smoking cessation among people with comorbid pain is more difficult to achieve. Smoking and pain have been proposed to influence each other through a maladaptive reciprocal positive feedback loop, in which pain increases motivation to smoke, and smoking worsens pain over time. Moreover, smoking withdrawal exacerbates pain, thus presenting an additional barrier to smoking cessation. However, the mechanisms underlying withdrawal-induced exacerbation of pain (hyperalgesia) and the real-world impact of withdrawal-induced hyperalgesia among people attempting to stop smoking, remain unclear.
By addressing a critical gap in scientific knowledge regarding the neural basis and behavioral impact of smoking withdrawal-induced hyperalgesia, this research will provide a foundation for development of targeted behavioral, pharmacological, and neurostimulation interventions to aid smoking cessation.
To fill this gap, Martucci and Dr. Maggie Sweitzer (contact PI) of Duke Psychiatry and Behavioral Sciences, will evaluate among people who smoke (PWS) with and without chronic pain: 1) the impact of smoking withdrawal on brain fMRI-based response to noxious heat stimuli and 2) the influences of withdrawal-induced hyperalgesia on the ability to abstain from smoking. Based on preliminary data, Dr. Martucci hypothesizes that 1) increased pain during smoking withdrawal will correlate with decreased activation of the bilateral inferior frontal gyrus (IFG) indicating reduced cognitive-affective regulation of pain, 2) PWS with chronic pain will exhibit greater withdrawal-induced deficits in IFG activation, and 3) chronic pain status and withdrawal-induced changes in pain ratings and pain-related brain activation will predict shorter time to lapse.
“Our research will examine how smoking withdrawal changes the way the brain processes pain, and whether these withdrawal-related changes interfere with the ability to stop smoking,” says Martucci, associate professor in anesthesiology and director of the Human Affect and Pain Neuroscience Laboratory at Duke Anesthesiology. “The results of this research will provide important information that can be used to guide the development of interventions to help people with chronic pain who smoke cigarettes to quit smoking and improve their health.”